Public health critical race praxis at the intersection of traffic stops and injury epidemiology

Background Law enforcement traffic stops are one of the most common entryways to the US justice system. Conventional frameworks suggest traffic stops promote public safety by reducing dangerous driving practices and non-vehicular crime with little to no collateral damage to individuals and communities. Critical frameworks interrogate these assumptions, identifying significant individual and community harms that disparately impact Black, Indigenous, and People of Color (BIPOC) and low-income communities. Methods The Public Health Critical Race Praxis (PHCRP) and multi-level frameworks from community anti-racist training were combined into a structured diagram to guide intervention and research teams in contrasting conventional and critical perspectives on traffic stops. The diagram divides law enforcement and drivers/residents as two separate agent types that interact during traffic stops. These two agent types have different conventional and critical histories, priorities, and perspectives at multiple levels, including individual, interpersonal, institutional, and cultural levels. Conventional solutions (identifying explicitly racist officers, “meet-a-cop” programs, police interaction training for drivers) are born from conventional frameworks (rewarding crime prevention regardless of cost, the war on drugs saves lives, driver behavior perfectionism). While conventional perspectives focus on individual and interpersonal levels, critical perspectives more deeply acknowledge dynamics at institutional and cultural levels. Critical solutions may be hard to discover without critical frameworks, including that law enforcement creates measurable collateral damage and disparate social control effects; neighborhood patrol priorities can be set without community self-determination or accountability and may trump individual and interpersonal dynamics; and the war on drugs is highly racialized and disproportionally enforced through traffic stop programs. Conclusions Traffic stop enforcement and crash prevention programs that do not deeply and critically consider these dynamics at multiple levels, not just law enforcement-driver interactions at the individual and interpersonal levels, may be at increased risk of propagating histories of BIPOC discrimination. In contrast, public health and transportation researchers and practitioners engaged in crash and injury prevention strategies that employ law enforcement should critically consider disparate history and impacts of law enforcement in BIPOC communities. PHCRP, anti-racism frameworks, and the included diagram may assist them in organizing critical thinking about research studies, interventions, and impacts.

Background Law enforcement traffic stops are one of the most common entryways to the US justice system. Conventional public health frameworks suggest traffic stops promote public safety by reducing dangerous driving practices while having little if any collateral damage to individuals and communities. Conventional law enforcement frameworks (Scalia 1996) see traffic stops as a legally valid reason to investigate any person viewed with suspicion, which may lead them to target individuals based on their intersectional identities rather than driving behaviors. Viewed critically through racialized history and context, traffic stops have clear harms at the individual, interpersonal, institutional, and cultural levels. These harms, especially those disparately affecting Black, Indigenous, and People of Color (BIPOC) and low-income communities, must be weighed against stated public health benefits.
Traffic safety interventions, including popular Vision Zero campaigns (Conner 2017), require a critical view of the role that traffic enforcement can play in public safety. There are proven interventions to reduce crashes and racial disparities in traffic stops, including one we evaluated previously in Injury Epidemiology (Fliss et al. 2020). Injury epidemiology has a long history of applying critical thinking frameworks such as the Haddon Matrix while conceiving and critiquing interventions. This commentary combines two frameworks, the Public Health Critical Race Praxis (PHRCP) and community anti-racism trainings, into a diagram that supports public health practitioners, researchers, and community groups to think critically about involving law enforcement in crash prevention.

Main text
What are critical race theory (CRT) and public health critical race praxis (PHCRP)?
Critical Race Theory (CRT) 'defines the set of anti-racist tenets, modes of knowledge production, and strategies a group of legal scholars of color in the 1980s organized into a framework targeting the subtle and systemic ways racism currently operates above and beyond any overtly racist expressions' (Ford and Airhihenbuwa 2018). CRT distinguishes itself from both colorblind approaches to racism, such as a feminism or class critique disconnected from intersectional race realities, and from civil rights approaches that seek redress for racism without changing underlying racist structures.
Ford and Airhihenbuwa called for CRT's inclusion in public health in 2010 (Ford and Airhihenbuwa 2010) and again in 2018 (Ford and Airhihenbuwa 2018), promoting the PHCRP as a semi-structured framework to facilitate the integration of CRT into public health research disciplines, including epidemiology, that produce and interpret evidence used for intervention evaluation and policy promotion.
We have not formally been formally trained in PHCRP (Ford and Airhihenbuwa 2018), so humbly offer our application as much to demonstrate its application to traffic stops as to advance our own understanding. We also draw on previous experience with community anti-racism training (through dismantling Racism Works and the Racial Equity Institute) based on frameworks from the People's Institute for Survival and Beyond (PISB) (The People's Institute 2019). These characteristics of institutions (Okun 2010) overlap with PHCRP in many ways. Contrasting the conventional view of racism as purely interpersonal, PISB-influenced trainings present racism as both hierarchical and nested (i.e., internalized racial superiority and inferiority, interpersonal interactions, institutional settings, and cultural context). This model mirrors multilevel (Diez 2002) frameworks used in social epidemiology (Gee 2008), traffic crash research (Adanu et al. 2017), geography (Kim and Subramanian 2016), and criminology (Jones and Pridemore 2018) settings.
Since its introduction, CRT and the PHCRP have been increasingly used to guide study design, interpretation, and suggest areas for future research. These applications are varied, including public park features in Latino immigrant neighborhoods (García et al. 2016), lead water contamination in Flint, MI Keywords: Traffic stop, Motor vehicle crash, Disparity, Crime, Law enforcement, Policing, Race, Anti-racism, Public health critical race praxis The interlocking and multiplicative approach to co-occurring social categories (e.g., race and gender) and the social structures that maintain them Failure to consider the interacting dynamics of racism alongside sexism, homophobia, and capitalism-e.g., implicit and explicit suggestions that race and racism operate the same for all people using or ascribed a certain identity / label). Failure to adopt a multilevel approach to addressing disparities-e.g., focusing exclusively on implicit bias training and behavioral interventions Address white supremacist culture components alongside (toxic) masculinity cultures and other privileges and marginalized identities. Act from a multi-tiered approach when addressing disparities, considering not only personal, but institutional and cultural levels of actions, e.g., considering patrol patterns and neighboring agency practices. Integrate traffic stop program interventions alongside anti-racist public health interventions in other areas, such as overdose and mental health response 10. Disciplinary self-critique

Action
The systematic examination by members of a discipline of its conventions and impacts on the broader society Critical voices in local government, public health, and law enforcement are suppressed in favor of a united front. Exceptional stories and counter examples are unwelcomed. History is generally ignored, especially any history that paints a discipline in a negative light (e.g., racist history of policing, public health, and local government social control) Critical voices are esteemed, rewarded, and developed. Critical frameworks are included in required training and treated as a conveyable skillset, not a magic alignment. History of intentional and unintentional racism within the discipline are taught with a focus on anti-racist action and change

Voice
Knowledge production, action Prioritizing the perspectives of marginalized persons; privileging the experiential knowledge of outsiders within Law enforcement is the sole voice in determining programs and producing knowledge about those programs, perhaps with some minimal accountability to local government. Marginalized population experiences can be "swept under the rug" because they may be relatively few. White and middle-class experiences are taken as the overall norm, driving attention away from experiences of marginalized groups. Exceptional events are treated as necessary sacrifices to maintain otherwise effective traffic stop programs. Only law enforcement determines whether programs work, their efficiencies, and the benchmarks of success The stories and experiences (individually and collectively) of people who are stopped are prioritized, particularly those who are most marginalized (people of color, justice involved populations, non-English speakers, etc.).
These communities lead determinations of not only how analysis is done, but how stop programs operate. In short, individuals and communities self-determine how they want to be patrolled and policed, or at least co-design stop programs with local agencies. The voice of those who are injured (e.g., by traffic crashes, assaults, or injuries from the justice system) are held up Columns marked with ( a ) are reprinted verbatim from Gilbert and Ray (2015) ( Muhammad et al. 2018), and law enforcement "justifiable" homicides of Black men (García et al. 2016).

Applying CRT/PHCRP to traffic stops
We follow the example from Gilbert and Ray (2015) by contrasting a conventional interpretation with a PHCRP interpretation for each principle in a tabular format based on literature review, community practice, and known disparities (Table 1). Themes from the conventional and critical contrasts are combined into a single figure describing these nested, multi-level dynamics within the unique nexus of traffic stops.

Nested, multi-level, dual-agent PHCRP framework for traffic stops
The conventional and PHCRP principles included in Table 1 could expand to its own full-length book. However, we believe there is utility in having a more condensed resource that connects the PHCRP framework to the traffic-stop setting visually. The PHCRP framework when expressed tabularly does not convey (1) the nested, multi-level dynamics of people, inter-personal interactions, institutions, and cultures, and (2) does not separate drivers and residents from law enforcement as unique loci for critical analysis, with their interaction being the nexus of the traffic stop. To that end, we built the following visual framework (Fig. 1) to contrast PHCRP and conventional frameworks nested within these multi-level structures, separating law enforcement and driver agents that meet at the traffic stop nexus. This figure and the PHCRP were used together to critically examine (1) limitations of a traffic stop intervention designed to reduce disparities and save lives (Fliss et al. 2020) and (2) issues with accurate measurement of traffic stop disparities (Fliss 2019).

Conclusions
We recommend using PHCRP as a framework to guide more equitable and less unjust traffic stop policies and public health/law enforcement collaborations. We acknowledge PHCRP may be uncritically applied; its application is not automatic approval for interventions without leadership from disparately impacted communities. In contrast, a truly critical framework must contend with the possibility that few to no aspects of traffic stop programs may be equitable under the PHCRP. However, given training in PHCRP, communities, public health, and law enforcement may co-design traffic stop injury prevention programs that are tightly limited by anti-racist ethics, efficient and effective in application, and serve to deepen community trust instead of endangering it. Whether this is overly idealistic or can be done in practice is yet to be determined. One way we have attempted to grapple with the application of PHCRP is to map it to dual-agent, nested traffic stop dynamics. While this diagram captures some nuances that the tabular form does not and may be useful as a blank template in group brainstorming sessions, it Fig. 1 Nested, dual-agent PHCRP framework for critical examination of traffic stop dynamics and interventions. Conventional frameworks prioritize the individual (behaviors and internalized mindsets) and interpersonal levels, and limit interaction to focus on the traffic stop itself as a time and level of interaction. PHCRP emphasizes higher levels dynamics (institutional, cultural), root and historical causes, and collateral consequences does not provide the same principle-specific contrasts as the full table. Researchers in other injury epidemiology settings may find utility in building diagrams that suit their research settings.
Both frameworks benefit from considering time in short (years) and longer (decades or centuries) scales. As acknowledged in the "the social construction of knowledge" principle, individual race-ethnicity is often tacitly used as a proxy for (or removed from) structural, historical, multi-generational racism and discrimination (VanderWeele and Robinson 2014). Frameworks such as PHCRP can help disentangle model variables by separating time and multi-level, structural phenomena such as racism. Sequencing important traffic stop related moments in time in the short term (e.g., pre-stop, stop, potential citation, potential search, potential arrest or use of force, etc.) and longer epochs (origins and historical milestones of policing and traffic stop enforcement) further separate those constructs.
We aspire to continual anti-racist learning and find PHCRP a useful framework for those efforts. Considering PHCRP principles under a multi-level framework of people, institutions, and culture may provide additional opportunities for reflection when applied to injury epidemiology related events such as traffic crashes and stops. We look forward to reading of its use in other injury epidemiology topics.

Abbreviations
CRT : Critical race theory; BIPOC: Black, indigenous, and people of color; PHCRP: Public health critical race praxis; PISB: People's Institute for Survival and Beyond.